Targeting women who deliver at one of the two UT-Houston teaching hospitals, Lyndon B. Johnson (LBJ) and Hermann Hospitals, pregnant women between 18 and 28 weeks gestation will be recruited from University of Texas/Harris County Hospital District-affiliated clinics, including Acres Homes, Aldine, Settegast, Baytown, and Squatty Lyons, LBJ and Hermann Hospital outpatient clinics, private practice OB/GYN's with patients who will deliver at Hermann Hospital, and area WIC (Women, Infants and Children) Program sites. Participants will be randomized to one of three groups, including 1) best practice (BP) counseling, 2) BP plus ultrasound, and 3) BP plus ultrasound plus motivational enhancement (ME) counseling. Counseling and cotinine testing will be performed at the University Clinical Research Center (UCRC) initially, at 34 weeks, and at 6 weeks postpartum. The primary outcome is the rate of smoking cessation among the women at 34 weeks gestation. Based on previous reports, projected quit rates for the 3 interventions, BP, BP + ultrasound, and BP + ultrasound + ME are .06, .12, and .20, respectively. A sample size of 360 will be necessary in order to observe these differences in quit rates. The chi-square test for trend in proportions will be used to determine statistical significance for this primary outcome.